Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?

Natsheh, Alaeddin; Shenfeld, Ofer Z.; Farkas, Amicur; Chertin, Boris

doi:10.1016/j.jpurol.2010.01.012

« Previous Next »Journal of Pediatric Urology
Volume 6, Issue 6 , Pages 600-604, December 2010

Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?

Alaeddin Natsheh
- Division of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
Ofer Z. Shenfeld
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
Amicur Farkas
- Division of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
Boris Chertin
- Division of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Department of Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
- Corresponding author at: Pediatric Urology Unit, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem 91031, Israel. Tel.: +972 2 6555560; fax: +972 2 6555299.

Received 2 December 2009; accepted 22 January 2010. published online 02 March 2010.

Abstract

Objective

Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients.

Patients and Methods

In 1988–2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18–64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR.

Results

The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients.